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Branchial Cleft Malformations, Pediatric

Pi Chun Cheng, MD, MS and Anita Bhandari, MD Reviewed 10/2018
 


BASICS

DESCRIPTION

  • Phylogenetically, the branchial apparatus represents the “gills” seen in fish and amphibians.

  • The fetal branchial apparatus is a foregut derivative and develops in the 2nd fetal week.

  • ...

DIAGNOSIS

HISTORY

  • Present since birth

  • Recurrent neck infections

  • Intermittent discharge from neck

  • Fever

  • Tenderness

PHYSICAL EXAM

  • Mass usually mobile

  • Usually a single lesion

  • Nonpulsatile

  • Lesion usually nontender ...

TREATMENT

MEDICATION

Antibiotics are indicated if the lesion is infected. 

SURGERY/OTHER PROCEDURES

  • Excision of the entire lesion is the standard approach.

  • Novel endoscopic and marsupialization approaches...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

  • Postoperative follow-up as outpatient for wound inspection

  • Observation for recurrence or reinfection

ALERT
  • Lesion may recur if not completely excised.

  • High incidence ...

ADDITIONAL READING

  • Acierno SP, Waldhausen JH. Congenital cervical cysts, sinuses and fistulae. Otolaryngol Clin North Am.  2007;40(1):161–176. [View Abstract on OvidInsights]

  • Adams A, Mankad K, Of...

CODES

ICD9

  • 744.49 Other branchial cleft cyst or fistula; preauricular sinus

  • 744.41 Branchial cleft sinus or fistula

  • 744.42 Branchial cleft cyst

ICD10

  • Q18.2 Other branchial cleft malformations

  • Q18.0 Sinus, f...

FAQ

  • Q: Can the cyst, fistula, or sinus recur?

  • A: Only a 3% recurrence rate is seen if the lesion is completely excised. A higher rate of recurrence is seen in cases of incomplete excision or with previ...

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